Heights University Hospital

All Charges

Charge

Type

Setting

Price

SCOOP GALLSTONE DESJARDINS 7MM

Facility

$784.20

Hospital Charge Code	270689563
Hospital Revenue Code	272
Min. Negotiated Rate	$117.63
Max. Negotiated Rate	$117.63
Rate for Payer: Qualcare PPO/HMO/WC	$117.63

SCOOP GALLSTONE DESJARDINS 8MM

Facility

$784.20

Hospital Charge Code	270689564
Hospital Revenue Code	272
Min. Negotiated Rate	$101.95
Max. Negotiated Rate	$392.10
Rate for Payer: Aetna Commercial	$235.26
Rate for Payer: Aetna Medicare Advantage	$235.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$199.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$199.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$199.97
Rate for Payer: Cigna Commercial	$392.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.95
Rate for Payer: Oxford Commercial	$392.10
Rate for Payer: Qualcare PPO/HMO/WC	$117.63
Rate for Payer: UnitedHealthcare Commercial	$392.10

SCOOP GALLSTONE DESJARDINS 8MM

Facility

$784.20

Hospital Charge Code	270689564
Hospital Revenue Code	272
Min. Negotiated Rate	$117.63
Max. Negotiated Rate	$117.63
Rate for Payer: Qualcare PPO/HMO/WC	$117.63

SCOOP GALLSTONE DESJARDINS 9MM

Facility

$784.20

Hospital Charge Code	270689565
Hospital Revenue Code	272
Min. Negotiated Rate	$117.63
Max. Negotiated Rate	$117.63
Rate for Payer: Qualcare PPO/HMO/WC	$117.63

SCOOP GALLSTONE DESJARDINS 9MM

Facility

$784.20

Hospital Charge Code	270689565
Hospital Revenue Code	272
Min. Negotiated Rate	$101.95
Max. Negotiated Rate	$392.10
Rate for Payer: Aetna Commercial	$235.26
Rate for Payer: Aetna Medicare Advantage	$235.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$199.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$199.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$199.97
Rate for Payer: Cigna Commercial	$392.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.95
Rate for Payer: Oxford Commercial	$392.10
Rate for Payer: Qualcare PPO/HMO/WC	$117.63
Rate for Payer: UnitedHealthcare Commercial	$392.10

SCOPE 4 RHINOLARYNGO SLIM

Facility

$850.00

Hospital Charge Code	270688726
Hospital Revenue Code	272
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$127.50
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

SCOPE 4 RHINOLARYNGO SLIM

Facility

$850.00

Hospital Charge Code	270688726
Hospital Revenue Code	272
Min. Negotiated Rate	$110.50
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$255.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.50
Rate for Payer: Oxford Commercial	$425.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.50
Rate for Payer: UnitedHealthcare Commercial	$425.00

SCOPE NANONEEDLE 125MM

Facility

$2,625.00

Service Code	HCPCS A4649
Hospital Charge Code	270699064
Hospital Revenue Code	272
Min. Negotiated Rate	$393.75
Max. Negotiated Rate	$393.75
Rate for Payer: Qualcare PPO/HMO/WC	$393.75

SCOPE NANONEEDLE 125MM

Facility

$2,625.00

Service Code	HCPCS A4649
Hospital Charge Code	270699064
Hospital Revenue Code	272
Min. Negotiated Rate	$341.25
Max. Negotiated Rate	$1,312.50
Rate for Payer: Aetna Commercial	$787.50
Rate for Payer: Aetna Medicare Advantage	$787.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$669.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$669.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$669.38
Rate for Payer: Cigna Commercial	$1,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$341.25
Rate for Payer: Oxford Commercial	$1,312.50
Rate for Payer: Qualcare PPO/HMO/WC	$393.75
Rate for Payer: UnitedHealthcare Commercial	$1,312.50

SCOPE SPYGLASS

Facility

$3,950.00

Hospital Charge Code	270664632
Hospital Revenue Code	272
Min. Negotiated Rate	$513.50
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$1,185.00
Rate for Payer: Aetna Medicare Advantage	$1,185.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,007.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,007.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,007.25
Rate for Payer: Cigna Commercial	$1,975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$513.50
Rate for Payer: Oxford Commercial	$1,975.00
Rate for Payer: Qualcare PPO/HMO/WC	$592.50
Rate for Payer: UnitedHealthcare Commercial	$1,975.00

SCOPE SPYGLASS

Facility

$3,950.00

Hospital Charge Code	270664632
Hospital Revenue Code	272
Min. Negotiated Rate	$592.50
Max. Negotiated Rate	$592.50
Rate for Payer: Qualcare PPO/HMO/WC	$592.50

SCOPE TOTE

Facility

$9.00

Hospital Charge Code	270658304
Hospital Revenue Code	270
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

SCOPE TOTE

Facility

$9.00

Hospital Charge Code	270658304
Hospital Revenue Code	270
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$2.70
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.17
Rate for Payer: Oxford Commercial	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$4.50

SCOPOLAMINE 0.4 MG/ML INJ

Facility

$19.25

Hospital Charge Code	60628945
Hospital Revenue Code	250
Min. Negotiated Rate	$2.89
Max. Negotiated Rate	$2.89
Rate for Payer: Qualcare PPO/HMO/WC	$2.89

SCOPOLAMINE 0.4 MG/ML INJ

Facility

$19.25

Hospital Charge Code	60628945
Hospital Revenue Code	250
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$9.62
Rate for Payer: Aetna Commercial	$5.78
Rate for Payer: Aetna Medicare Advantage	$5.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.91
Rate for Payer: Cigna Commercial	$9.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.50
Rate for Payer: Oxford Commercial	$9.62
Rate for Payer: Qualcare PPO/HMO/WC	$2.89
Rate for Payer: UnitedHealthcare Commercial	$9.62

SCOPOLAMINE 1.5 MG/24 HR TDM

Facility

$40.13

Service Code	NDC 67434604
Hospital Charge Code	60629044
Hospital Revenue Code	250
Min. Negotiated Rate	$6.02
Max. Negotiated Rate	$6.02
Rate for Payer: Qualcare PPO/HMO/WC	$6.02

SCOPOLAMINE 1.5 MG/24 HR TDM

Facility

$40.13

Service Code	NDC 67434604
Hospital Charge Code	60629044
Hospital Revenue Code	250
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$20.07
Rate for Payer: Aetna Commercial	$12.04
Rate for Payer: Aetna Medicare Advantage	$12.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.23
Rate for Payer: Cigna Commercial	$20.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.22
Rate for Payer: Oxford Commercial	$20.07
Rate for Payer: Qualcare PPO/HMO/WC	$6.02
Rate for Payer: UnitedHealthcare Commercial	$20.07

SCOPOLAMINE HBR OPHY .25% 5ML

Facility

$82.60

Hospital Charge Code	6004840
Hospital Revenue Code	251
Min. Negotiated Rate	$12.39
Max. Negotiated Rate	$12.39
Rate for Payer: Qualcare PPO/HMO/WC	$12.39

SCOPOLAMINE HBR OPHY .25% 5ML

Facility

$82.60

Hospital Charge Code	6004840
Hospital Revenue Code	251
Min. Negotiated Rate	$10.74
Max. Negotiated Rate	$41.30
Rate for Payer: Aetna Commercial	$24.78
Rate for Payer: Aetna Medicare Advantage	$24.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.06
Rate for Payer: Cigna Commercial	$41.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.74
Rate for Payer: Oxford Commercial	$41.30
Rate for Payer: Qualcare PPO/HMO/WC	$12.39
Rate for Payer: UnitedHealthcare Commercial	$41.30

SCOPOLAMINE HBR PATCH 0.5MG

Facility

$86.40

Hospital Charge Code	6004857
Hospital Revenue Code	252
Min. Negotiated Rate	$12.96
Max. Negotiated Rate	$12.96
Rate for Payer: Qualcare PPO/HMO/WC	$12.96

SCOPOLAMINE HBR PATCH 0.5MG

Facility

$86.40

Hospital Charge Code	6004857
Hospital Revenue Code	252
Min. Negotiated Rate	$11.23
Max. Negotiated Rate	$43.20
Rate for Payer: Aetna Commercial	$25.92
Rate for Payer: Aetna Medicare Advantage	$25.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.03
Rate for Payer: Cigna Commercial	$43.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.23
Rate for Payer: Oxford Commercial	$43.20
Rate for Payer: Qualcare PPO/HMO/WC	$12.96
Rate for Payer: UnitedHealthcare Commercial	$43.20

SCOPOLAMINE SOL OPH 0.25%

Facility

$173.65

Hospital Charge Code	60628067
Hospital Revenue Code	250
Min. Negotiated Rate	$26.05
Max. Negotiated Rate	$26.05
Rate for Payer: Qualcare PPO/HMO/WC	$26.05

SCOPOLAMINE SOL OPH 0.25%

Facility

$173.65

Hospital Charge Code	60628067
Hospital Revenue Code	250
Min. Negotiated Rate	$22.57
Max. Negotiated Rate	$86.83
Rate for Payer: Aetna Commercial	$52.09
Rate for Payer: Aetna Medicare Advantage	$52.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.28
Rate for Payer: Cigna Commercial	$86.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.57
Rate for Payer: Oxford Commercial	$86.83
Rate for Payer: Qualcare PPO/HMO/WC	$26.05
Rate for Payer: UnitedHealthcare Commercial	$86.83

SCOPPETTE-PROCTO 061225

Facility

$4.00

Hospital Charge Code	270061225
Hospital Revenue Code	270
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

SCOPPETTE-PROCTO 061225

Facility

$4.00

Hospital Charge Code	270061225
Hospital Revenue Code	270
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

Know your out-of-pocket cost for care.

All Charges